Some specialties have taken a hit from advances in technology, but maybe I'm short sighted there are a few specialties I can't see "dying out" until we reach some star trek type of technolgy. For Example Orthopedics. If you have a displaced fracture into a joint, I can't think of a single way other than manipulating the fragment and fixing it to have a satisfactory result. Along with the hundreds of other things they do. Same with Neurosurgery and a burst fracture to the spine, simple mechanics I cant think of any possible way to reduce the encroachment on the spinal cord other than physically moving the piece.

Interesting question, considering you start off by saying this type of discussion annoys you.

IR is dying.

Click to expand...

Hehe yeah, . Well, it annoys me because its kinda rude and for now, I think ALL specialties are needed. So when people say that without giving good proof (like an essay), I have a little problem beleiving it.

People have been saying for years that general surgery is dying out (because of increased specialization, "stents" according to one SDN wag, whatever). Tell that to the hospitals that are clamoring for them and the wide choice of positions you can get.

Keep in mind as well that a few years ago there was alot of talk about how the market was going to be completely saturated with Cardiologists and Gastroenterologists. We all know that they are begging for their paychecks these days...

I'm not sure who is saying that surgical fields are dying out or why they would say that. It seems to me that surgery is as needed now in all aspects of medicine as it ever was. Sure, non-invasive techniques will change the practice of medicine and surgery (e.g. the massive decrease in exploratory laparatomies after development of CT in the 80s, the near disappearance of DPL due to easy access to CT, decrease in diagnostic angiograms due to development of CTA and MRA, etc), but this will just change the practice, not kill it. Judging by the volume of interventional radiology work that we have, I don't expect IR to die out either. We do little vascular work in comparison to our vascular surgery colleagues at my institution, but the volume of non vascular work is continually increasing. I think innovation will always be present and will advance both surgery and surgical subspecialties and IR.

WBC, are general radiologists doing IR nowadays or is that reserved for fellowship trained radiologists? I've heard that IR fellowships have trouble filling and are taking applicants from non-radiology backgrounds.

too tired for a full tirade, but i think many often confuse "dying out" with "changing".

have many medical/surgical fields changed? yes.
have they redefined what it is to be in that field? yes.
do those fields still exist? yes.

so what i'm saying is that change is real. evolution is real. but extinction, in fact, is rare.

look at trauma surgeons. or vascular guys. or even the cardiac surgeons who are "dying out". in fact, there is quite a nice niche for cardiac surgery, just not in the percentage that it was before. so the field is re-inventing itself. and it's supply and demand curve. but it will not cease to be. it might just alter.

i am not a doomsday crier. and i can think of no "vestigial" fields these days. well, except alchemy. and that has evolved into chemistry. but in recent history most fields (if they are smart) have changed. they have fluxed. redefined. re-invented.

but none, that i can recall, has ceased to be. and i challenge all to think of a field of medicine that does no longer exist. at least in name. i can think of some that have been born (e.g. radiation oncology). but none (even fam med, which is far different than it used to be) has ceased to be.

so be practical when you choose. i.e. do NOT choose a field for earning benefits, prestige, etc. because those CAN change. but for love of the system, question, approach. those things will not.

Keep in mind as well that a few years ago there was alot of talk about how the market was going to be completely saturated with Cardiologists and Gastroenterologists. We all know that they are begging for their paychecks these days...

Click to expand...

Hmmm.... The region I'm in, the Cardiologists are at each other's throats for patients. The patient's with good insurance at least.

WBC, are general radiologists doing IR nowadays or is that reserved for fellowship trained radiologists? I've heard that IR fellowships have trouble filling and are taking applicants from non-radiology backgrounds.

Click to expand...

Some general rads in smaller hospitals do full spectrum IR including angio. Most general rads everywhere will do basic procedures: CT or US guided biopsies, fluid drainages (para/thora/cyst), arthrograms. In addition, most graduates these days are fellowship trained (I'd say at least 70%) and they usually get further procedures in the field they pursue (bone fellows doing bone biopsies, epidurals, nerve root blocks, vertebroplasties, neuro fellows doing neuro angio, body fellows doing advanced body procedures including tumor ablation (RF or cryo), chest fellows doing lung biopsies, mammo fellows doing stereotactic / us guided breast biopsies, etc). All of these procedures could also be done be a general rad with the proper experience and training and often are at smaller facilities.

The IR fellowships that don't fill with rads residents are usually pretty poor programs to begin with and lack essential components of a complete IR program.

my personal favorite method of checking out whether a field is dying or not is to go online and look for jobs
neurosurgery for example - plenty of opportunities, and these are the ones that are advertised on internet job-searching services. check out magazines, special classifieds, etc. not to mention the offers straight out of residency.

"dying out" is a very relative term. is a move into CT surgery a bad move? well, look at the number of jobs there are. but look at the number of people in it. it's like millions of openings for computer techies, consultants, etc. and millions of grads each year.

or about three hundred openings for nsg, CT, etc. per year, but only 100 new surgeons produced each year, with a significant veterans retiring. is the field dying?

its BIG NUMBER entering divided by BIG NUMBER openings or
its little number entering divided by little number openings

so again, is it dying? shrinking? maybe. dying? you gotta remember that 99% of the population can't even make it to medical school. now you're talking specialized surgery? 0.01% of the jobs out there for 0.001% of qualified people. the numbers are smalled, compared to, say, accountants, but, IMO, the demand is still there.

for repetition's sake, it's 5 applicants for 10 openings or 5000 applicants for 10000 openings. your average applicant in this pool of 5010 people would think "only ten openings!? good god that would have been a terrible career move. i'd stick to the job offering 10000 openings so i won't have to be jobless!" they forget that for those ten openings, only five people in his pool are qualified. so demand, in this case, is the same.

There will always be a need for both general surgery and surgical specialties.

The oft-cited example for a dying surgical specialty is CT. It's a field that has changed dramatically since new interventional therapies have evolved in Cardiology, but there will always be a need for bypass operations. But those going into the specialty can give you much better examples than I can...

Neurosurgery? There will always be a need for craniotomies (at least), so I have a hard time believing that Neurosurgery will be a dying field. Nevermind the vast spectrum of additional procedures that they can do.

Sure, other medical specialties like GI, Neuro, and Renal are evolving and becoming more aggressive in management and procedures, and this will result in changes in what, how, and when surgical therapies are used.

But to say that surgical specialties are dying is a pretty big stretch IMO...

About SDN

We are a non-profit academic community founded in 1999. Our mission: help students become doctors.

Join thousands of fellow college students, health professional students and practicing doctors from across the United States and Canada. Membership is always free, anonymous, and member information is never sold or shared with other organizations.

Student Resources

Donate Today!

As part of our mission, we ensure our student resources are always provided for free or at cost. In addition to our free forums and data-driven resources, we also archive excellent online services, blogs, and publish multiple books for our community.

Make a tax-deductible donation and receive an immediate forums account upgrade!